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Who calls the shots in your group?

October 2016

Published in the October 2016 issue of Today’s Hospitalist

WHO WOULD YOU like to see put into power? I’m not asking who you’re voting for in next month’s presidential election, but about leadership and decision-making in your hospitalist group.

Our cover story takes a look at governance models being used by different programs. We talked to seven hospitalist groups about how they set group policies and make decisions on everything from scheduling and workflow to coding and patient experience.

Governance issues become more complex as programs get bigger. In six-physician groups, after all, it’s easy to gather all the principals in one room and ask for a show of hands.

But that type of one-clinician-one-vote system has its downsides. As one of our sources put it, you can put 12 internists in a room to discuss an issue and hear 13 opinions. And trying to reach consensus among scores of providers is out of the question.

That’s why many bigger groups move to some type of structured government, creating committees—or councils or cabinets—to represent the interests of rank-and file physicians. In some groups, executive members are site leaders or the heads of major group initiatives like quality improvement. In other groups, council members are elected to serve a set term.

But such formal governance can raise some serious questions, like how large should councils be and how long should members’ terms last. But perhaps the biggest challenge is how to make sure that representatives and the decisions they make reflect the will of the physicians in their group.

Communication is critical, as is giving physicians who disagree with decisions some form of recourse. The good news is that the groups we spoke with say they have built transparency into their governing process. That keeps their clinicians not only well represented, but well informed.

edoyleEdward Doyle
Editor & Publisher

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